GW1-2022-07907_Well Construction - GW1_20220823

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WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
CHRISTOPHER WATCHER 1a:WATE1rzoNEs
Well Contractor Name FROM TO DESCRIPTION
4448A ft. ft. 0
R, i
NC Well Contractor Certification Number ft. / _
,15(;OUTER;CASING fdeimultr=cas'e tweUs"O 1INERiifia Uealile ? .-
CUMMINGS DEVELOPMENTS, INC FROM TO DIAMETER THICKNESS MATERIAL
Company Name +1 R' fL 6 5/8 In. .188 G.STEEL
I.\ 46!INNER CASING'OR'T.UBING?I eo'thert 2it'closed=l6o 1 I ?•t z�*2.Well Construction Permit#: W 7 " O ZS Z FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well conslruclionpermits(I.e.UIC,CannOg State,Variance,etc.) ft. ft.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17i SCREEN:': y-, -
Agricultural FROM TO DIAMETER SLOTSI7,E THICKNESS MATERIAL
Municipal/Public ft• ft. in.
Geothermal(Heating/Cooling Supply) aResidential Water Supply(single)
ft. ft. in.
IndusWal/Commercial Residential Water Supply(shared) _
T
Irrigation 18_GROU ,'
FROM TO MATERIAL EMPLACEMENT METHOD&AM
_ Monitoring OUNT• Non-Water Supply Well: o fL zo ft
PORT.CEMENT POUR
_'Recovery ft•
Injection Well: ft.
Aquifer Recharge r3Groundwatcr Rcmcdiation fL fL
Aquifer Storage and Recovery [Salinity Barrier 49:;SAND/GRAYEL'PACK-ifa`1lcetile ;. ;,
TO MATERIAL "
Aquifer Test DStorntwater Drainage FROM ft fL EMPLACEMENT METHOD
Experimental Technology 0 Subsidence Control fL tL
Geothermal(Closed Loop) OTracer 20rDRILLiNG;LOG ettacS additlolidlaheets";iGriccesaa 3`_
Geothermal(Hearin Coolin Return) rJOther(explain under#21 Remarks) FROM TO DESCRIPTION(color hardness sollfrock e, min size,etc.)
20 ft.
4.Date Well(s)Completed —a— �iZ Well ID# 2d ft. 190 fL
5a.Well Location:
11PhnA t� v��rnr�In �Qvkes �• rt. 4:_, `•' _
Facility/Owncr Net& Facility ID#(if applicable) ft• ft AUG O r.
40b8 L.dco2k tl. ft.
Physical Address,City,and Zip ft. -ft.
9893391 a49 '21 REINARKS:
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latAong is sufficient)
/ 22.Certifies'
J _N 790 of g� W 7
100
6.Is(are)the well(s)oi Permanent or OTemporary ignaturc o if ell Contractor Date— _Z z
e
ify that the
7.IS this a repair to an existing well: Yes or EgNo milli r15AJNCAC 02C.OlOOeor 1SArNCAC 02C..01001 Well Constructionructed Standatrds and accordant ce
a
jthis is a repair,full out known well construction in and explain the nature ofthe copy of this record has been provided to the well owner.
repair under#21 remarks section or on the back of thisforal.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: 11
„Idlu�+ SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft.)
For multiple wells list all depths if different(example-3 n 20W and 2©1001) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
0.Static water level belcasing.
use
top of casing:_ (ft.) Division of Water Resources,Information Processing Unit,
jrvater level!s shove casin ,rrre"+"
1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (in.)
24b.For Infection Wells: In addition to sending the form to the address in 24a
12.Well construction method: ROTARY above,also submit one copy of this form within 30 days of completion of well
(i.e.auger,rotary,cable,direct push,etc.) construction to the following:
FOR WATER SUPPLY WELLS ONLY: Division of Water Resources,Underground Injection Control Program,
> 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) C.. Method of test: AIR ROTARY 24c.For Water SO y&Iniectlon Wells: In addition to sending the form to
13b.D.sfofection HTH the addresses) above, also submit'one copy of this form within 30 days of
type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources
Revised 2-22-2016